Prevalence of and risk factors for anaemia in patients with advanced chronic liver disease

Bernhard Scheiner; Georg Semmler; Florian Maurer; Philipp Schwabl; Theresa A Bucsics; Rafael Paternostro; David Bauer; Benedikt Simbrunner; Michael Trauner; Mattias Mandorfer; Thomas Reiberger

doi:10.1111/liv.14229

Prevalence of and risk factors for anaemia in patients with advanced chronic liver disease

Liver Int. 2020 Jan;40(1):194-204. doi: 10.1111/liv.14229. Epub 2019 Sep 13.

Authors

Bernhard Scheiner^{1

2}, Georg Semmler^{1

2}, Florian Maurer^{1

2}, Philipp Schwabl^{1

2}, Theresa A Bucsics^{1

2}, Rafael Paternostro^{1

2}, David Bauer^{1

2}, Benedikt Simbrunner^{1

2}, Michael Trauner¹, Mattias Mandorfer^{1

2}, Thomas Reiberger^{1

2}

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
² Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.

Abstract

Background: Anaemia is common in advanced chronic liver disease (ACLD) as a result of various risk factors.

Aims & methods: We evaluated the prevalence and severity of anaemia as well as the impact of anaemia on clinical outcomes in consecutive patients with ACLD and portal hypertension.

Results: Among 494 patients, 324 (66%) patients had anaemia. Anaemic patients showed higher MELD (12 ± 4 vs 9 ± 3; P < .001), lower albumin (34 ± 6 vs 39 ± 5 g/dL; P < .001) and more often Child-Pugh B/C stage (56% vs 17%; P < .001). The prevalence of moderate-severe anaemia (haemoglobin <10 g/dL) increased with the degree of portal hypertension (HVPG: 6-9 mm Hg: 22% vs HVPG: 10-19 mm Hg: 24% vs HVPG ≥ 20 mm Hg: 36%; P = .031). The most common aetiologies of anaemia were gastrointestinal bleeding (25%) and iron deficiency (9%), while reason for anaemia remained unclear in 53% of cases. Male gender (odds ratio [OR]: 1.94 [95% CI: 1.09-3.47]; P = .025), MELD (OR: 1.20 [95% CI: 1.09-1.32]; P < .001), hepatic decompensation (OR: 4.40 [95% CI: 2.48-7.82]; P < .001) and HVPG (OR per mm Hg: 1.07 [95% CI: 1.02-1.13]; P = .004) were independent risk factors for anaemia. Anaemia was associated with hepatic decompensation (1 year: 25.1% vs 8.1%; 5 years: 60.3% vs 32.9%; P < .0001), hospitalization (73% vs 57%; P < .001) and a higher incidence rate of acute-on-chronic liver failure (0.05 [95% CI: 0.04-0.07] vs 0.03 [95% CI: 0.01-0.04]). Anaemic patients had worse overall survival (1 year: 87.1% vs 93.7%, 5 year survival: 50.5% vs 68.6%; P < .0001) and increased liver-related mortality (1 year mortality: 9.7% vs 5.7%, 5 year mortality: 38.0% vs 26.9%; P = .003).

Conclusion: Two-thirds of patients with ACLD suffer from anaemia. The degree of hepatic dysfunction and of portal hypertension correlate with severity of anaemia. Anaemia is associated with decompensation, ACLF and increased mortality in patients with ACLD.

Keywords: advanced chronic liver disease; anaemia; portal hypertension; prevalence; severity.

MeSH terms

Adult
Aged
Anemia / epidemiology*
Anemia / etiology*
Anemia, Iron-Deficiency / epidemiology
Austria / epidemiology
Chronic Disease
Female
Gastrointestinal Hemorrhage / complications
Humans
Hypertension, Portal / complications
Hypertension, Portal / physiopathology
Liver / physiopathology
Liver Diseases / complications*
Liver Diseases / physiopathology
Male
Middle Aged
Prevalence
Retrospective Studies
Risk Factors
Sex Factors
Survival Analysis
Time Factors